Am J Pathol. 2023 Jul 06. pii: S0002-9440(23)00237-7. [Epub ahead of print]
Stress response pathways are crucial for cells to adapt to physiological and pathological conditions. Increased transcription and translation in response to stimuli places a strain on the cell, necessitating increased amino acid supply, protein production and folding, and disposal of misfolded proteins. Stress response pathways such as the Unfolded Protein Response (UPR) and the Integrated Stress Response (ISR) allow cells to adapt to stress and restore homeostasis; however, their role and regulation in pathological conditions such as hepatic fibrogenesis are unclear. Liver injury promotes fibrogenesis through activation of hepatic stellate cells (HSCs), which produce and secrete fibrogenic proteins to promote tissue repair. This process is exacerbated in chronic liver disease, leading to fibrosis and, if unchecked, cirrhosis. Fibrogenic HSCs exhibit activation of both the UPR and ISR, due in part to increased transcriptional and translational demands, and these stress responses play important roles in fibrogenesis. Targeting these pathways to limit fibrogenesis or promote HSC apoptosis are potential anti-fibrotic strategies, but are limited by our lack of mechanistic understanding of how the UPR and ISR regulate HSC activation and fibrogenesis. In this article we explore the role of the UPR and ISR in the progression of fibrogenesis and highlight areas that require further investigation to better understand how the UPR and ISR can be targeted to limit hepatic fibrosis progression.
Keywords: ATF6α; Cirrhosis; Endoplasmic Reticulum; GCN2; HRI; IRE1α; Integrated Stress Response; PERK; PRK; Unfolded Protein Response